（3-3）骨折各论.ppt

1、Fracture,刘震宁 副主任医师 Peking University First Hospital,Fracture of the clavicle,Fracture of the clavicle,most common in both children and adults occur in the region of mid third and lateral third part,Clinical Appearance,Definite injury history Local pain, swelling, pressing pain, can palpate the displ

2、aced fragment of fracture and the rubbing sound X-ray,Treatment (1),Non Operative Treatment Reduction by hand External fixation by “8” bandage,:,Indications of Operative Treatment Nonunion Nerve and Vascular Injury Difficult to maintain the fracture by close reduction Soft tissue between fractures O

3、pen fracture,Treatment (2),Surgical neck Fracture of humerus,Happen in any age, most common in middle-age and elders. Classification Undisplaced Abducted Adducted Comminuted,Clinical Appearance,Definite injury history Local pain, swelling, deformity, pressing pain, movement disorders X-ray,Treatment

4、,Undisplaced hang by triangle towel for 34 weeks Abducted and adducted reduction by hand external fixation Comminuted Operative Treatment,Humeral shaft fracture,肱骨外科颈以下12cm至肱骨髁上2cm之间的骨折。,三角肌止点以上 近折端-向内、向前 远折端-向外、向近 三角肌止点以下 近折端-向前、外 远折端-向近,Easily injury radial nerve radial nerve pass through the midd

5、le third and lower third of humerus.,中下1/3骨折易损伤桡神经：垂腕,各手指掌指关节不能背伸，拇指不能背伸，前臂旋后障碍；手背桡侧皮肤感觉减退或消失。,肱骨中下1/3骨折，注意有无桡N损伤。,Non-Operation Operation Difficult reduction by non-operation Radial nerve injury,Treatment,Supracondylar Fracture of the Humerus,Anatomy,Anterior-medially to the humeral condyle-humeral

6、 artery and median nerve pass. Medial to humeral condyle-ulnar nerve Lateral to humeral condyle-radial nerve,Normal elbow joint,Classification,Extension,Flexion,Injury history (hand against the ground) Sign: elbow swell, pain and subcutaneous gore. Examination pressing pain bone sound pseud-joint mo

7、vement Normal post-elbow triangle relation Nerve and vascular injury or not. Extension Fx easily injury blood vessel and nerve,Diagnosis,特别注意伸直型骨折,近端前下移位损伤肱动脉,软组织肿胀,影响远端肢体血液循环,前臂骨筋膜室综合征、缺血性肌挛缩,Fracture of the shaft of ulna and radius,Diagnosis,Attention:,bone fascial compartment syndrome 前臂高张力肿胀，剧痛；

8、桡动脉搏动摸不清；手指皮温降低，感觉异常，主动活动障碍，被动活动剧痛 Ischemic muscle contracture 5P sign (Painlessness, Pulselessness, Pallor, Paresthesia, Paralysis),Monteggias Fracture,Ulna upper third fracture accompanied with radial head dislocation,Galeazzis Fracture,Radial lower third fracture accompanied with ulnar head dislo

9、cation,Treatment,Fracture of radius and ulna (both bones fracture),Monteggia fracture,Galeazzi fracture,Fracture of the distal radius,桡骨远端关节面 掌倾 1015 尺偏 2025,Colles Fracture -伸直型 Smith Fracture -屈曲型 Barton Fracture -关节面骨折伴腕关节脱位,Fracture of distal radius,1. Colles Fracture,radial distal fragment move

10、s to radial and dorsal side.,多见于成年人和老人 典型畸形 “餐叉”畸形-背侧移位 “枪刺刀”畸形-桡侧移位,2. Smith Fracture,radial distal fragment moves to radial and palmar side. (Reverse Colles fracture),Smiths Fracture,Colles Fracture,3. Barton Fracture,桡骨远端背侧或掌侧骨折，累及关节面，腕关节随之移位,Treatment:,手法复位外固定 切开复位内固定,恢复掌倾角、尺偏角,损伤桡神经 垂腕,骨筋膜室综合症,

11、损伤肱动脉 缺血性肌挛缩,结节与骨干交界易骨折,骨折并发症,三种畸形,Fracture of the femoral neck,解剖特点,颈干角1307(平均127) 前倾角107(1215),成人股骨头的血供来源： 旋股内、外侧动脉在股骨颈基底形成的动脉环 以旋股内侧动脉为主 圆韧带内的小凹动脉 股骨干滋养动脉的升支,股骨颈骨折会影响股骨头血供，发生股骨头缺血坏死或骨折不愈合。,Most commonly in the older Indirection violence,Classification,According to the displacement degree: Garden

12、: Incomplete Fracture Garden : Complete, Non-displaced Garden : Complete, partly displaced Garden : Complete, fully displaced,According to X-ray: Adduction Pauwels 50 Unstable Easy to diaplace Abduction Pauwels 30 Stable uneasy to displace,According to the fracture site: Subcapital femur fracture 对股

13、骨头血供影响很大 Transcervical neck fracture Baseline neck fracture 对股骨头血供影响较小,Clinical appearance,Middle-aged or elder had fall history Hip pain after injury Limited lower limb activity Unable to standing and walking Patients with stable Fx could walk, but few days later, appeared hip pain and difficult to

14、 walk.,Clinical appearance,Affected limb in external rotation, usually between 45-60 Local pressing pain Axis knocking pain Affected limb is shorten X-ray :,identify fracture site, type and displacement., 大转子上移征：,Treatment,Non-operation Unmarked displaced Fx Abduction and inserted stable Fx Elder wi

15、th bad general condition 需长期卧床，现已较少采用,Treatment,Operation Adduction Fx and displaced Fx Older than 65 Yrs with subcapital femoral Fx Teen-age femoral neck Fx Dated femoral neck Fx Operation method Closed reduction and internal fixation Open reduction and internal fixation Arthroplasty,Screws,Total h

16、ip arthroplasty,Complication,Avascular Necrosis (Subcapital fracture),Intertrochanteric fracture,解剖特点：,Trochanteric zone pain Swelling, lower limb unable to move. Physical examination Trochanteric zone pressing pain external rotation 90and shortening of lower limb X-ray,Clinical appearance,Treatment

17、,Non-operation skeleton traction，尽量少用 Operation DHS PFNA, -nail,DHS内固定,闭合复位，PFNA内固定,Femoral neck fracture & Intertrochanteric fracture 相同点： 常见于老年人，骨质疏松性骨折； 外伤后髋部疼痛伴活动障碍； 常见患肢外旋畸形； 髋部有压痛、叩痛，纵向叩击痛(+)。 不同点： 股骨颈骨折 粗隆间骨折 解剖关系： 髋关节囊内 囊外 局部肿胀： 不明显 明显，可见瘀斑 外旋程度： 60 更大，90 愈合： 移位后不愈合率高 易愈合 股骨头血供： 影响， 不影响 易发生股骨头坏死,Thank you,